Business strategy and healthcare

CDC Report Shows An Increase in Suicide Rates

There was widespread media coverage of suicide following the deaths of Kate Spade and Anthony Bourdain as well as a research from the Centers for Disease Control and Prevention that concluded suicide rates have increased in the US over the past 20 years. USA Today, Alltucker reported the suicides of Anthony Bourdain and Kate Spade are part of a broader trend of suicides among middle-aged adults. The article pointed out that “middle-aged adults had the highest number of suicides and largest rate increases, according to the” CDC report. The article added, “The CDC said nearly half of people who died by suicide had a known mental health condition. But those without a known mental health condition were more likely to struggle with a significant life event.”

Tanner of the AP reported that Joshua Gordon, MD, the director of the National Institute of Mental Health, said the CDC’s finding that many people who died by suicide had no known mental illness suggests that many people are “undiagnosed and untreated.”

Meanwhile, Carey of the New York Times reported the deaths of Spade and Bourdain “were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation.” The article pointed out that while “treatment for chronic depression and anxiety – often the precursors to suicide – has never been more available and more widespread,” the recent increase in the national suicide rate poses the question: “if treatment is so helpful, why hasn’t its expansion halted or reversed suicide trends?” Thomas Insel, MD, the former director of the National Institute of Mental Health, said that the expanded access to treatment might be insufficient for the increased demand for such services.

Consider that the U.S. Suicide Rates Are Rising Faster Among Women Than Men

Rhitu Chatterjee noted that the number of people dying by suicide in the United States has risen by about 30 percent in the past two decades. And while the majority of suicide-related deaths today are among boys and men, a study published Thursday by the National Center for Health Statistics finds that the number of girls and women taking their own lives is rising.

“Typically there are between three and four times as many suicides among males as among females,” says Dr. Holly Hedegaard, a medical epidemiologist at the NCHS and the main author of the new study. In 2016, about 21 boys or men out of 100,000 took their own lives. On the other hand, just six girls or women out of 100,000 died by suicide that year.

But when Hedegaard and her colleagues compared the rise in the rates of death by suicide from 2000 to 2016, the increase was significantly larger for females — increasing by 21 percent for boys and men, compared with 50 percent for girls and women.

There’s “sort of a narrowing of the [gender] gap in rates,” Hedegaard notes. The biggest change was seen among women in late middle age. “For females between the ages of 45 and 64, the suicide rate increased by 60 percent,” she says. “That’s a pretty large increase in a relatively short period of time.”

You’re Not Alone

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting 741741.

That the increase for women was more than double the increase for men “did indeed surprise me,” says Nadine Kaslow, a psychologist at Emory University and the past president of the American Psychological Association, who was not involved in the study. She says she finds the overall trends for both men and women “disturbing.”

Scientists don’t yet know the reasons behind the steeper rise in the number of girls and women taking their own lives, says Kaslow. “We’re really just beginning to see these differences, and so people are just now beginning to look at this.”

Though there are different factors at play in each case, excessive stress is a known risk factor for suicide overall, she says.

“People often die by suicide when they just feel totally overwhelmed,” Kaslow says.

Consider that more than a third of adults take medications that increase the risk of depression, study suggests

Johnson of the Washington Post (6/12, Johnson) “Wonkblog” reports, “More than a third of American adults are taking prescription” medicines, “including hormones for contraception, blood pressure medications and medicines for heartburn, that carry a potential risk of depression,” researchers concluded after analyzing data from “a detailed survey of thousands of American adults taken every two years between 2005 and 2014, in which people opened their medicine cabinets and showed researchers all the prescription” medications “they had taken in the last month.” Those people were also evaluated for depression.

And Lardier of the U.S. News & World Report reported of the study which revealed that “approximately 15 percent of adults who used three or more of these medications simultaneously experienced depression, compared to five percent not taking the” medications, seven “percent taking only one” medicine, and nine “percent taking two” medications simultaneously. The study authors also “observed the symptoms in” medicines “that listed suicide as a side effect but also saw similar results when they excluded participants taking psychotropic medications, which is considered an indicator of underlying depression unrelated to medication use.” The findings were published online June 12 in the Journal of the American Medical Association.

The CDC reported that the U.S. Suicide Rates Have Climbed Dramatically

According to the American Psychological Association, women say their stress levels have risen in recent years. And middle-aged women belonging to the sandwich generation are especially feeling the pressure of their many responsibilities at home and at work.

“So they may be taking care of children, of parents, have work demands and then more responsibilities,” Kaslow says.

There’s also been a rise in the last few decades in the number of single-parent households headed by women. That means more women trying to do everything alone, she says. “And so there’s, sort of, stress everywhere,” she says. “They may not have time to take care of themselves, to be kind to themselves, to get the social support they need.”

The new report also shows that more adolescent girls are choosing to end their lives, notes Kaslow. So the problem is not specific to middle-aged women but across all age groups.

“Suicide is a public health concern,” says Jill Harkavy-Friedman, the vice president of research at the American Foundation for Suicide Prevention. The statistics published Thursday underscore the need for a national prevention effort, she adds.

The report also looked at the means of suicide, as recorded in death certificates, and found that firearms remain an important method, particularly for boys and men.

“For males, pretty much from age 15 and older, the majority of the suicides [involved] firearms,” says Hedegaard.

“We know that limiting access to lethal means of any kind can reduce suicide,” Harkavy-Friedman says, “especially if you limit access during a crisis moment.”

To help prevent suicide, society needs to offer better access to mental health care, she says. And each one of us can do our bit, too, by watching out for the warnings signs among friends and family.

Be aware, she says, if you notice something’s changing in a loved one, friend or colleague. For example, if their mood is changing, she says, “maybe they’re more irritable, or withdrawn. Maybe they’re talking about being a burden.”

At times like these, it is important to let people know they’re not alone. “It sounds simple,” she says. “But it does make a difference.”

There may be one big reason suicide rates keep climbing in the US, according to mental-health experts

Leanna Garfield and Hilary Brueck stated that Anthony Bourdain died on Friday, with early reports indicating that the beloved celebrity chef and TV host killed himself. Earlier in the week, the fashion designer Kate Spade died by suicide as well.

Their deaths are part of a nationwide trend. Since 1999, suicide rates in the US have risen by nearly 30%, and mental illness is believed to be one of the largest contributors.

Mental-health experts say that a decline in funding for mental health care has also contributed to the rise.

Those who can afford out-of-pocket costs for mental-healthcare services are more likely to seek them out and receive treatment.

Anthony Bourdain, the acclaimed chef who explored the globe in search of the world’s best cuisine, died by suicide on Friday in France, CNN said. The fashion mogul Kate Spade also died by suicide earlier this week.

Their deaths are part of larger trend in the US. Since 1999, suicide rates in the US have risen nearly 30%, according to the Centers for Disease Control and Prevention. Nearly every state has seen a rise over that period.

While suicide is a complex response to trauma that often involves many factors, mental illness is one of the leading contributors, according to the CDC. But for those who have a mental illness and can’t afford mental health care, their conditions are more likely to worsen.

According to mental-health experts, that reality makes suicide a far-reaching, systemic public health crisis.

John Mann, a psychiatrist at Columbia University who studies the causes of depression and suicide, said several factors had most likely contributed to America’s rising suicide rates, including stress from the 2008 financial crisis and the current opioid epidemic. But they don’t tell the whole story.

“We have a serious, national problem in terms of adequate recognition of psychiatric illnesses and their treatment. That is the single most effective suicide-prevention method in Western nations,” he told Business Insider. “We’re missing most of these cases. That’s really the bottom line.”

Many people who took their own lives and had a history of psychiatric illness were not receiving treatment at the time of their deaths, according to the CDC.

The US has made substantial cuts to mental-healthcare funding over the past decade

Making mental health care more affordable could help lower suicide rates in the US, Mann said.

In the years after the 2008 recession, states cut more than $4 billion in public mental-health funding.

A budget outline released by President Donald Trump in February proposed slashing a key source of public funds for mental-health treatment: the Medicaid program serving over 70 million Americans with lower incomes or disabilities.

“We have a national strategy for suicide prevention in the United States, but it’s essentially unfunded, and there is no government leadership in systematically implementing this strategy at the federal or state level,” Mann said. “So we have a blueprint, but we do not act on that blueprint.”

Today, many Americans simply cannot afford mental-health services — something that may be because of a flawed healthcare system. A 2014 study published in JAMA Psychiatry found that of all practicing medical providers in the US, therapists were the least likely to take insurance: In 2010, only 55% of psychiatrists accepted insurance plans, compared with 89% of other healthcare professionals, like cardiologists, dermatologists, and podiatrists.

In the US, therapy can cost hundreds of dollars per session when patients pay out of pocket. Prices are usually even higher in cities, which also tend to have higher rates of depression than in rural areas.

‘This is a wake-up call for employers, regulators, and the [insurance] plans themselves’

Mental-health care coverage can vary widely by state as well.

In November, Milliman, a risk-management and healthcare consulting company, published a national study that explored geographic gaps in access to affordable mental health care.

The researchers parsed two large databases containing medical-claim records from major insurers for preferred provider organizations, or PPOs, covering nearly 42 million Americans in all 50 states and Washington, DC, from 2013 to 2015.

The study found that in New Jersey, 45% of office visits for behavioral healthcare were out of network; in DC, it was 63%. In nine states — including New Hampshire, Minnesota, and Massachusetts — payments were 50% higher for primary-care doctors when they provided mental health care.

Of the study, Henry Harbin, the former CEO of the behavioral-healthcare company Magellan Health, told NPR: “This is a wake-up call for employers, regulators, and the [insurance] plans themselves that whatever they’re doing, they’re making it difficult for consumers to get treatment for all these illnesses. They’re failing miserably.”

Because mental-healthcare providers know that insurance companies aren’t likely to adequately reimburse them, they will often require patients to pay out of pocket. As a result, many states do not have enough in-network therapists and psychiatrists to meet patient demand.

“Too many people have no health insurance; there have been too many budget cuts to treatment dollars, and there are too few providers available to deliver care,” Fred Osher, the director of health systems and services policy at the Council of State Governments Justice Center, wrote in a New York Times op-ed article in 2016. “These obstacles should lead to a call to action, not a call to further confine people with mental illness.”

Correlation does not equal causation. But many other nations with universal or near-universal healthcare, like the Netherlands and Estonia, have seen declines in suicide rates, Mann said.

Following reports of Bourdain’s and Spade’s deaths, many people on Twitter shared stories of their own battles with depression and mental illnesses. Several also expressed worries about those who are unable to pay for therapy visits or psychiatric medications because their insurance plans do not cover them.

If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, get help. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

How does this information fit into my interest in health care besides the basic problems in our mental health system? One of the suggestions that I have heard from the “talking heads” is that all physicians should be asking all of our patients about their stresses, concerns for depression indicators as the professionals on the media telling us that we should be able to pick up the early signs.

Interesting suggestions but most of us, especially those physicians employed by the corporate health care systems, we barely have time to diagnose and start patients on their treatment in the allotted 11-15 minutes per patient as we are pushed to see more and more patients per day to increase their production models-profits first.

You all also have to understand my feeling regarding suicide, as I have watched friends, physicians and their sons and daughters commit suicide. I consider it the most selfish way to solve their problems. They leave the sorrow, the resolution of problems to their loved ones that they leave behind.

Happy Father’s Day to all the Dads out there! I hope that you all enjoyed your special day.